NORWALK — Navigating end-of-life care is a difficult process with no right answers. Is it better to go into the hospital for another round of chemotherapy that may extend your life, or to spend your remaining time at home? Is better for a loved one to be resuscitated from a heart attack if he or she only has days to live?

“It’s a series of trade-offs,” said Dr. Damanjeet Chaubey, the medical director of palliative care at Western Connecticut Health Network. She said there are trade-offs that are acceptable to some patients and not others.

“A patient may say, ‘Quality of life is becoming more important to me rather than having too many things happen to me.’ How do we make that possible? That’s a discussion with patients and their families.”

Voluntary training for such conversations was recently implemented statewide on Oct. 1.

Medical Orders for Life-Sustaining Treatment (MOLST) is a program offered by the Department of Health that physicians, physician assistants and nurses throughout Connecticut can choose to participate in. The program consists of conversations with patients about end-of-life care. Resulting decisions are documented on lime green sheets that patients post on their refrigerators and their health-care providers keep on file.

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State near top of list

Connecticut ranked third in the nation for the most days spent in the hospital by patients in the six months before they died in 2014

National average: 7.9

Connecticut average: 9.3

• Hartford: 8.8

• New Haven: 9.4

• Bridgeport: 10.6

Connecticut ranked third highest in the nation for amount of time people spent in the hospital during their final days in 2014, coming in after New York and New Jersey, according to a study by the Dartmouth Institute. On average, people in Connecticut spent 9.3 days out of the last six months of their lives in the hospital, compared to a national median of 7.6.

“More than 80 percent of patients say that they wish to avoid hospitalization and intensive care during the terminal phase of illness,” the study read. “But those wishes are often overridden by other factors.”

For this reason, many states have implemented programs similar to MOLST. According to Public Health Commissioner Raul Pino, 47 states have or are developing similar programs.

“I think Connecticut is a little late,” Chaubey said. “Many other states already had something similar to MOLST for a long time. And I think society is starting to think about having discussions about: What is important to me?”

Because of the importance of end-of-life decisions, the Western Connecticut Health Network had already come up with a process of documenting patients’ preferences. When patients come into the network, which includes Norwalk, Danbury and New Milford hospitals, for palliative care, information from a series of difficult conversations is recorded in the electronic medical record.

“Frankly speaking, it’s not any different from what we’re doing right now,” Chaubey said of MOLST. “We have very robust palliative care teams at our hospitals.”

But she acknowledge the bright green form has the added benefit of being statewide. The hope is that it will become easily recognizable by a wide range of professionals, including emergency responders. Patients can currently receive highlighter-orange do-not-resuscitate bracelets to ensure their end-of-life decisions are honored; the lime forms will serve a similar function while providing more detailed information.

The Western Connecticut Health Network hopes to receive training for and begin implementing MOLST by the end of the month.

However, Chaubey emphasized that the form is only as effective as the forethought and time that goes into the documented decisions. Trade-offs between extending life and maintaining its quality are difficult to to negotiate.

“People are scared. They are suffering, oftentimes from different aspects of their disease,” she said. “And these are not one-time conversations.”